Israel has shut the door on non-governmental organizations advocating for those in Gaza in need of medical treatment not available in the besieged territory. (Hatem Omar/MaanImages)

Mutasem Billah Abu-Mastfa was born in Gaza. Though he is just nine months old, his parents are already trying to get him out of the Strip.

Abu-Mastfa was born with severe congenital heart defects -- his heart, riddled with holes, is on the right side of his chest. He is currently receiving treatment at al-Nasser Pediatric Hospital in Gaza, but his condition is deteriorating. And due to the ongoing Israeli blockade the medical system in Gaza -- short on supplies, its staff unable to leave the Strip to obtain further training -- is unable to cope with such a complicated case.

On 13 September, Abu-Mastfa was expected to arrive at an Israeli facility, Sheba Hospital in Tel Hashomer. There he was due to receive the care that might prolong, or even save, his life. But the date came and went and he remained in Gaza. Abu-Mastafa's parents submitted an application to enter Israel for medical treatment more than two weeks prior to the admission date. However, they never received a response from the Israeli authorities, leaving the couple unable to take their son to the doctors who were waiting for him.

After a Palestinian's request to exit Gaza has been refused or ignored, an Israeli human rights organization such as Gisha (Access), Physicians for Human Rights-Israel, or HaMoked: Center for the Defense of the Individual, would ordinarily step in. The organizations contact the Gaza District Coordination Office (DCO), the Israeli governmental body that grants exit permits. Palestinians cannot contact the DCO themselves. Instead, they must give their applications to the Palestinian Civil Affairs Committee (PCAC), which is unable to issue exit permits and has only the token power of passing along requests to the Israelis.

The NGOs, or non-governmental organizations, on the other hand, do what the PCAC can't -- they advocate. By contacting the DCO directly, coordinating between Palestinians in Gaza and the Israelis who control the border, NGOs sometimes expedite exit from the Strip. Human rights organizations also appeal denied applications, supplying the DCO with statements from Israeli physicians who clarify the urgency of the patients' exit. In this manner, the human rights organizations have successfully facilitated medical care, in Israel and other nearby states, for hundreds of Palestinians.

But on 14 September, the DCO shut the door on Israeli NGOs, leaving the needy Palestinians in Gaza who are represented by them, including Abu-Mastfa, with nowhere to turn.

On that day, Gisha, Physicians for Human Rights-Israel and HaMoked received a letter from the head of the DCO, Colonel Moshe Levi, informing them that their requests to assist Palestinians would not be processed. Rather, requests for exit filed by NGOs on behalf of Palestinians in Gaza, including those in need of urgent medical care, will be passed to the PCAC, which will then forward them to the DCO. The DCO will no longer communicate with human rights organizations, leaving Palestinians with no way to appeal or expedite decisions, effective immediately.

The letter, Colonel Levi stated, was a "clarification" intended to "serve the Palestinian population of the Gaza Strip."

"Best wishes for a happy new year," Colonel Levi wrote as he signed off.

Rather than "happy," the NGOs were shocked and outraged. This "clarification" of procedure came after years of working directly with the DCO. In the past, Colonel Levi has stated that his office "exists for humanitarian reasons." And in recent months, Colonel Levi has expressed the desire to strengthen relations between the DCO and the human rights organizations.

Gisha, Physicians for Human Rights-Israel and HaMoked united with other human rights organizations to compose a fiery response to Colonel Levi.

"This kind of conduct, in which a government authority attempts to impede the activities of human rights organizations, to drive them away and to make their work more difficult -- to effectively boycott them -- is characteristic of tyrannical regimes and is inconceivable in a democratic state," the organizations wrote in a letter issued on 17 September.

They added that the DCO's "refusal to respond to the appeals of human rights organizations and Israeli attorneys constitutes a grave humanitarian blow to the Palestinian residents of the Gaza Strip." The NGOs urged Colonel Levi to revoke the decision.

Keren Tamir of Gisha explained that the DCO's move is the latest act in Israel's ongoing campaign against human rights organizations, which began in the wake of the NGOs' criticism of Israel's invasion of Gaza last winter. In recent months, Tamir said that Israeli Prime Minister Benjamin Netanyahu "spoke to the British Prime Minister about not funding [the Israeli NGO] Breaking the Silence. The Ministry of Foreign Affairs has established a new department to inquire if the NGOs -- a symbol of democracy -- act by Israeli law."

Of the DCO's refusal to communicate with human rights organizations, Tamir commented that "It's very troubling. It looks like another means to narrow the activity of the human rights organization."
Is hindering the NGOs that assist Palestinians the new face of the Israeli blockade?

"It's another way to further detach Gaza from the West Bank," Tamir responded. "And it definitely makes [circumstances] harder for the Palestinians in Gaza -- they only have a slight chance to exit and enter Gaza even in extreme humanitarian cases."

Ami Gill of Physicians for Human Rights-Israel added that "If it [the DCO's change in policy] continues, then yes, it's not only a continuation, it's an additional aspect of the blockade."

The Palestinian Ministry of Health estimates that 260 access-related deaths have occurred since the Israeli blockade of the Gaza Strip began in June 2007. Physicians for Human Rights-Israel reports that there are between 600 and 800 monthly requests to exit Gaza via the Israeli-controlled Erez Crossing to travel to Israel or other nearby countries for medical treatment. Approximately 37-40 percent of the applications filed with the PCAC are either denied or delayed. Gill stated, "The human rights NGOs in Israel, specifically those who deal with the Palestinians in West Bank and Gaza, are the only channel these people have ... all others are blocked or do not exist."

The story of Karima Abu Dalal, a 33-year-old Palestinian resident of Gaza who suffered from Hodgkin's lymphoma, paints a stark picture of what might lie ahead for Palestinian patients in the Strip. After the Rafah Crossing with Egypt was closed in 2007, Abu Dalal traveled to Nablus to continue the chemotherapy she previously received in Egypt. After undergoing two rounds of chemotherapy in the West Bank in August of 2007, doctors noted an improvement in her condition. But they emphasized that more treatment was necessary to prevent a reoccurrence.

Abu Dalal was scheduled to receive two more courses of chemo, again in Nablus. Her first application, submitted to the PCAC and forwarded to the DCO, was denied for "security reasons." Her second application was ignored and Abu Dalal missed her medical appointments in the West Bank.

Physicians for Human Rights-Israel turned to the Israeli high court in December of 2007. They included in their petition the testimony of an Israeli physician who stressed that Abu Dalal would die unless she continued to receive treatment. The Israeli high court declined to intervene.

Karima Abu Dalal died in Gaza in November of 2008.

Unless the DCO's decision is reversed, Gill said, "There will be a severe decline in the number of patients who can access treatment." That means there will be more stories like Abu Dalal's. That means Abu-Mastfa, the nine-month-old baby who is trapped in Gaza, might meet a similarly tragic fate.

Mya Guarnieri is a Tel Aviv based journalist and writer and a regular contributor to The Jerusalem Post. Her work has also appeared in Outlook India - India's equivalent to and subsidiary of Newsweek - as well as Maan News Agency, Common Ground News Service and other international publications.